Combining diabetes and mental health care: An ethnographic exploration of user involvement in combined care.

PURPOSE: To explore and describe the enactment of user involvement and combined care in a Danish clinic that aimed at providing integrated diabetes and mental health care. DESIGN: An ethnographic study. DATA SOURCES AND METHODS: Data consisted of field notes from 96 hours of participant observations and field notes from 32 informal conversations with healthcare providers, users and relatives as well as 12 semistructured interviews with users. Data were analysed using a thematic analysis. This study reports to the SRQR guidelines. RESULTS: Treatment was not combined as intended if only one healthcare provider handled the consultations. Here, the healthcare providers' focus was often on their own area of expertise-either mental health or diabetes. If more than one healthcare provider handled consultations, the consultations were often divided between them, focussing on one condition at the time. Healthcare providers noted, that learning from peer colleagues was a way to increase the possibility for combined care. Furthermore, combined care was highly dependent on the healthcare providers' ability to involve users' illness experiences in their own care planning. Here, a high level of user involvement increased the levels of combined care during consultations. CONCLUSION: This study set out to explore and describe user involvement and combined care in a specialised diabetes and mental health outpatient clinic. Combined care is complexed and requires that healthcare providers are well-equipped to manage the complexity of delivering care for people with both conditions. The degree of combined care was linked with the healthcare providers' ability to involve users and their knowledge on the condition outside there are of expertise. RELEVANCE TO CLINICAL PRACTICE: A peer-learning environment in combination with clinical guidelines and joint display could support healthcare providers in involving users in own care and when delivering care outside their area of expertise. PUBLIC CONTRIBUTION: No patient or public contribution. Due to the COVID-19 pandemic, the original user council withdraw their consent to participate due to health-related worries and anxiety concerning the pandemic. The user council consisted of three members diagnosed with diabetes and severe mental illness. They were invited to participate in physical meetings, phone or online meetings. Presenting findings from the study to the study participants were also hindered by the second lockdown. This influenced the possibility for data triangulation.

An exploration of the psychological impact and support needs of nurses during a pandemic: A qualitative systematic review.

AIM: When a public health emergency occurs, nurses play an important role on the front lines and experience tremendous physical and mental stress. This review aims to synthesize existing qualitative studies exploring the psychological impact and support needs of nurses. DESIGN: Qualitative systematic reviews. Registered in PROSPERO (CRD42021288509). METHODS: This review uses the PEOD framework to explicitly identify qualitative questions and systematically searches four electronic databases (CINAHL, MEDLINE, PubMed, PsychINFO) for articles published between 25 March 2000 and 27 December 2020. RESULTS: A total of 10 studies published in English from 2005 to 2020 were included in the review. Following the quality critical appraisal, 26 concepts were extracted and six descriptive themes were synthesized into three analytical themes: (1) positive psychological drive, (2) need more formal supports and (3) need to be treated fairly. During sudden public health incidents, it is crucial to provide support to family members, offer psychological counselling and isolation training to nurses, while considering cultural factors and appropriate methods. Organizations and governments should prioritize establishing a robust and effective psychological support system.

Perspectives of socioeconomically disadvantaged parents on their children's coping during COVID-19: Implications for practice.

Disruptions caused by COVID-19 have the potential to create long-term negative impacts on children's well-being and development, especially among socioeconomically disadvantaged children. However, we know little about how socioeconomically disadvantaged families are coping with the pandemic, nor the types of support needed. This study presents qualitative analysis of responses to an open-ended question asking parents how children are coping with the restrictions associated with COVID-19, to identify areas in which these cohorts can be supported. Four main themes were identified: health concerns, schooling difficulties, social isolation and adjustment to restrictions. Health concerns included exacerbation of pre-existing health conditions, fear about the virus, difficulty getting children to understand the pandemic and increased sedentary behaviour. Schooling difficulties referred to the challenges of home schooling, which were behavioural (e.g. difficulty concentrating) and logistical (e.g. technology). Social isolation, expressed as missing friends, family and/or institutions was common. Finally, parents expressed that children experienced both positive adjustments to restrictions, such as spending more time with family, and negative adjustments such as increased screen time. Many responses from parents touched on topics across multiple themes, indicating a need for comprehensive, holistic assessment of children's and families' needs in the provision of support services. The content of the themes supports calls for resources to support children and families including increased financial and practical accessibility of social services, physical health and exercise support, mental health support and COVID-19 communication guides.

Parent Perceptions of Remote Instruction for Students with Extensive Support Needs

In the wake of the COVID-19 pandemic, schools shifted to nontraditional education overnight, disrupting learning for millions of children in the United States. Despite the broad impact of these shifts in schooling, its effects have not been uniform. How would the specialized instructional supports known to be effective in meeting the needs of students with extensive support needs (ESN) be provided remotely? We interviewed eight mothers of students with ESN to learn how nontraditional education impacted the educational experiences of students with ESN. Our findings included the overall perception that nontraditional education was highly unsuccessful and could not replace in-person learning for participants' children. Findings also highlighted challenges participants experienced when working to support their children's at-home learning, as well as the unexpected benefits participants reported from remote service delivery that may be considered as future recommendations of instructional practices for students with ESN. [ FROM AUTHOR]

The Impact of Covid-19 Pandemic on Services for Persons with Neurodevelopmental Disorders: An Italian Case

The COVID-19 pandemic has had severe effects on social health services worldwide. Many people with neurodevelopmental disorders have lost their professional support. The interruption of supportive assistance has been devastating since it has negatively affected their continuity of care as well as their social inclusion and socialization. This paper aims to illustrate the impact of the COVID-19 on an Italian Public Social Health System Services for people with disability. It highlights and discusses the strategy that was adopted in order to ensure the continuity of care assistance provided to the service clients as the organization of emergency remote support and individual support services for independent living. An exploratory study was conducted involving the entire population of people with neurodevelopmental disorders (n=333) included in the Disability System Services of Udine (Friuli Venezia Giulia Region, North-East Italy) to analyze the main repercussions occurred on the organization of services during the pandemic period. A comparative analysis of the number of persons enrolled in the different types of support services and of individuals' support needs, evaluated throught the Support intensity scale (SIS), pre- and post-pandemic crisis (January 2020 - January 2021) was conducted. The data shows that, despite the enormous difficulties, the adopted strategy has succeeded in limiting the risks of isolation and the negative impact on individual interventions, and opened the way to new alternative and innovative strategies for planning and implementing support.

Design of a Remote Coaching Program to Bridge the Gap From Hospital Discharge to Cardiac Rehabilitation: Intervention Mapping Study.

BACKGROUND: Remote coaching might be suited for providing information and support to patients with coronary artery disease (CAD) in the vulnerable phase between hospital discharge and the start of cardiac rehabilitation (CR). OBJECTIVE: The goal of the research was to explore and summarize information and support needs of patients with CAD and develop an early remote coaching program providing tailored information and support. METHODS: We used the intervention mapping approach to develop a remote coaching program. Three steps were completed in this study: (1) identification of information and support needs in patients with CAD, using an exploratory literature study and semistructured interviews, (2) definition of program objectives, and (3) selection of theory-based methods and practical intervention strategies. RESULTS: Our exploratory literature study (n=38) and semistructured interviews (n=17) identified that after hospital discharge, patients with CAD report a need for tailored information and support about CAD itself and the specific treatment procedures, medication and side effects, physical activity, and psychological distress. Based on the preceding steps, we defined the following program objectives: (1) patients gain knowledge on how CAD and revascularization affect their bodies and health, (2) patients gain knowledge about medication and side effects and adhere to their treatment plan, (3) patients know which daily physical activities they can and can't do safely after hospital discharge and are physically active, and (4) patients know the psychosocial consequences of CAD and know how to discriminate between harmful and harmless body signals. Based on the preceding steps, a remote coaching program was developed with the theory of health behavior change as a theoretical framework with behavioral counseling and video modeling as practical strategies for the program. CONCLUSIONS: This study shows that after (acute) cardiac hospitalization, patients are in need of information and support about CAD and revascularization, medication and side effects, physical activity, and psychological distress. In this study, we present the design of an early remote coaching program based on the needs of patients with CAD. The development of this program constitutes a step in the process of bridging the gap from hospital discharge to start of CR.

Social Support of Organ Donor Families in China: A Quantitative and Qualitative Study.

Background: Donor families experienced a difficult time during and after the process of organ donation. There is a necessity to understand the support they received and what they need to help them get through a painful time. This study aimed to investigate the social support level and social support needs of the donor families in China. Methods: A cross-sectional study was conducted among 102 donor families using a questionnaire to investigate their demographics and social support level. To further understand their social support needs, in-depth interviews were conducted among 9 donor families. Results: Findings of the study showed that (1) Most of the family members (74, 72.6%) lacked social support, and only a small number of families (28, 27.5%) received sufficient social support (2). The coping style had an impact on the overall social support level (P = 0.014) (3). There was a lack of emotional support, information support and material support toward the donor's family members. Both emotional support and material support are significantly needed. Conclusions: The overall social support level remained insufficient and the utilization degree of social support was low. Organ donor families are in desperate need of material and emotional support. The level of social support is largely influenced by the donor familie's coping style. Compared with a negative coping style, donor families who adopted a positive coping style acquire more social support.

Difficulties and Needs of Adolescent Young Caregivers of Grandparents in Italy and Slovenia: A Concurrent Mixed-Methods Study.

Many adolescent young caregivers (AYCs) care for a grandparent (GrP) with chronic disease, especially in countries with no or low developed long-term care systems and/or level of awareness of and policy responses to young caregivers. This mixed-methods study aimed at shedding light on the needs and difficulties faced by a sample of 162 adolescents aged 15-17, caring for GrPs, living in Italy (87) and Slovenia (75), respectively. A multiple linear regression model was built for the quantitative data. Qualitative data were content analysed using an open coding process. Italian and Slovenian respondents reported a moderate amount of caring activity and relatively high positive caregiving outcomes. Nevertheless, one out of three AYCs reported health problems due to their caring responsibilities. Compared to their Italian counterparts, Slovenian respondents were supported to a lesser extent by public services. Italian respondents faced communicative and practical problems; Slovenian AYCs experienced mainly emotional discomfort. AYCs from both countries requested emotional and practical support from formal services and family networks. Further, Slovenian AYCs requested emotional support and a personalized learning plan from schoolteachers. Support measures aimed at training AYCs of GrPs on geriatric care are recommended to address specific issues related to ageing and long-term care needs.

Understanding the Educational Support and Psychosocial Needs of Parents and Adolescents With Kawasaki's Disease and Coronary Artery Aneurysms.

INTRODUCTION: Kawasaki disease (KD) with coronary artery aneurysms (complex KD) presents relentless challenges for families. Psychosocial experiences and needs were explored. METHOD: A descriptive, exploratory study of adolescents and parents using a needs survey and psychosocial instruments (anxiety, depression, and functional impairment). RESULTS: Fifty-one parents and 38 adolescents participated. Predominant interests were for information sheets, newsletters, Web sites, and phone applications. Gaps in disease-specific knowledge and awareness of coronary artery aneurysms between parents and adolescents were identified. Psychosocial concerns for adolescents included symptoms of anxiety (22%), depression (13%), and functional impairment (22%). Multivariable analyses indicated higher depression scores associated with longer travel distance from specialists (p = .04). Parent-reported social concerns for their adolescent were associated with higher anxiety (p = .005) and functional impairment (p = .005). Written commentary complemented the findings. DISCUSSION: Care protocols require psychosocial assessment/referral and the use of virtual platforms. The groundwork was laid for developing patient and family-centered strategies.

'Policing' a pandemic: Garda wellbeing and COVID-19.

In response to the global pandemic COVID-19, the Irish government has called upon the Garda Síochána to implement an unparalleled mode of policing to mitigate and contain the spread of the Coronavirus. Studies investigating smaller scale epidemics, such as Severe Acute Respiratory Syndrome (SARS), indicate that staff at the frontlines of an outbreak are exposed to an insuperable amount of stress and experience increased psychological morbidities as a result. Furthermore, research not only indicates that heighted levels of psychological distress are an occupational hazard associated with the law enforcement profession, but that members of the Garda Síochána feel their mental health needs are largely unmet by their organisation. Given the pandemic's propensity to expose officers to indeterminate echelons of physical and psychological threat; there has never been a more appropriate time to explore the potential burdens associated with 'policing' a pandemic, question the governments capacity to address the psychological support needs of frontline professionals, and plan future research for best practice.